You are the primary care provider for a 9-month-old child. Hehas presented to your primary care office for a sick visit at theend of December as his mother reports that he has a cough that is”getting worse.” He began with nasal congestion three days ago anda cough and fever to 101 two days ago.
He is nursing but less than normal and is not very interested ineating. He will drink water from a sippy cup. He has had multiplewet diapers, and his mother feels that he has been hydratingadequately. She has been giving him 5 mL of acetaminophen PRN forfever control.
He was the product of a FTVD without complications. His pastmedical history is unremarkable with the exception of intermittentpatches of eczema on his back for which he uses triamcinolone 0.1%cream BID, PRN. There is no known trigger for his eczema. Hisfamily history is unremarkable. He does not have any surgicalhistory. There is no second-hand smoke exposure. He attends daycarefour days a week, and his mother reports that many other childrenseem to have the same symptoms.
His mother reports that over the past 24 hours she has observedhim to be breathing “faster” than normal and his “belly seems to begoing up and down.” She notes a “wheezy cough and tons of clearmucus from his nose.”
On exam:
T—100.8 (tympanic), Wt—24 lbs 3 oz, SpO2—94%, HR—146,RR—42
The child is alert and smiling, with copious amount of clearnasal drainage. He is noted to have abdominal breathing withintercostal retractions. Mild nasal flaring is noted. There isdiffuse inspiratory and expiratory wheezes with scattered, finecrackles throughout. His cardiac examination is normal except forthe tachycardia. Examination of the throat and ears is normal.
- How would you communicate your concerns to the mother?
- What do you suspect is the cause for his cough, rhinorrhea, andwheezing?
- How would you recommend managing his symptoms? Will this childrequire any type of diagnostic workup?
